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NPI Code Detail

MEDICARE: MR. KEITH EDWARD GREWE PT

MEDICARE:  MR. KEITH EDWARD GREWE  PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist002062KY

General Provider Information

NPI Number : 1700067832
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEITH EDWARD GREWE PT
Provider Business Mailing Address
First Line : 4316 CALEVARES DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40514-1301
Country : US
Telephone Number : 859-224-3564
Fax Number :
Provider Business Practice Location Address
First Line : 4316 CALEVARES DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40514-1301
Country : US
Telephone Number : 859-224-3564
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2007
Last Update Date : 04/17/2014

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Directions to “ MR. KEITH EDWARD GREWE PT” Practice Location

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